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TechnologyAdvice Guide to Medical Billing Software

Although electronic medical records, data analytics technology, and wearable devices command most of the healthcare industry’s attention, it’s still billing software that serves as the integral cog in the revenue cycle – a cycle that determines the profitability or failure of healthcare providers. And while these newer technology could represent innovative additions to medicine, medical billing software has continued to evolve as well, with some products now featuring powerful analytics capabilities of their own.

Choosing billing management software is no different than choosing an EHR or practice management product; due diligence is required. Larger practices may select all-encompassing products that integrate with an EHR as part of a practice management system, while smaller practices may need products that only handle billing.

In order to determine which system will work best for your practice, this guide explores common billing software features, details the difference between integrated and standalone products, and examines trends in the billing software industry.

Common Features

Insurance Billing

To describe the billing process as arduous would be an understatement. Insurance companies often change the criteria for medical necessity, and remittance of denied claims can grind revenue intake to a halt. This is especially true when claims must be resubmitted multiple times.

This feature of billing software helps providers better manage the claims process by automating claims submissions as well as denials and re-submissions. Billing software also often allows providers to track the status of their claims, as well as set up electronic submission with payers whom they work with on a regular basis. Some platforms also allow providers to quickly verify patient insurance coverage and adjust codes as required.

While it may seem an obvious choice, it’s worth noting that automating your revenue cycle with billing software can lead to much greater control over your finances, as you can now track which claims have been paid, which have been denied, and which are in limbo. This insight is invaluable, and makes paper-based submission through fax and direct mail seem antiquated.

Claims Scrubbing

The most common factors for claim denial originate from human error. Inaccurate patient information, such as mismatched names and identification numbers, as well as errors in technical information, like mistyped procedure codes, slow down reimbursement rates and add to the lengthy process of submitting claims to payers.

Claims scrubbing refers to a software function that cleans the data entered into electronic claims form, hence the “scrubbing” reference. Scrubbing features have two levels of validation. The first simply deals with data entry errors. A common example is correcting mistyped procedure codes prior to claim submission, such as age-specific codes.

The more complex function of a scrubbing engine uses an if-then rules engine to expand from merely correcting clerical errors to calculating medical necessity of a procedure based on gender, date of procedure, facility, and other additional factors. It’s this deeper functionality that makes scrubbers so powerful, with quality software allegedly able to achieve over 95 percent claim acceptance.

Batch Payments

With a batch payment feature, billing systems can manage payments from multiple payers and patients at the same time, replacing manual shuffling and sorting with automation. Batch payment functionality is useful for pursuing patient payments because most systems can create multiple emails and direct mail forms that provide the patient with details of their payment responsibilities.

More advanced billing software may also feature online bill pay and credit card processing, which can be offered through a patient portal or on another page of your website. This function helps providers scale their billing systems (without hiring additional staff) as they begin to see more patients.

Financial Reports

Though data analytics are en vogue for population health management, most providers, particularly those in private practice, simply need reporting capabilities that highlight the financial performance of their practice over a period of time, or through a specific filer. While reporting features can overlap with practice management software, some billing systems allows users to produce reports detailing revenue sources, claims acceptance and denial rates, and any revenue loss from outstanding payments.

Billing systems necessarily become more complex as the size of the facility increases, but for physicians starting a new practice, billing software is often the first software purchased, and the one most commonly used.

Types of Systems

There are two broad types of medicalbilling management systems: those that integrate with other medical software like practice management and electronic medical records systems, and those that work only as stand-alone platforms. The trend in healthcare is toward integration, but standalone products are often cheaper and may feature simpler functionality that works better for smaller practices that don’t plan on purchasing an EHR and PM system in the near future.

Integrated

Billing management systems that integrate with the aforementioned types of software often include much more expansive functionality, a feature that could be viewed as a positive or negative depending on the perspective of the buyer. Integration does offer providers the benefit of seamlessly transferring data between the three main types of systems without fear of human error interfering too heavily in the process. If the systems within a practice don’t interface naturally, providers will have to contact vendors to create custom integration architecture, which is both costly and time consuming. Further, with Meaningful Use criteria driving the best medical software vendors and providers to pursue interoperable products, it’s becoming easier to find vendors that offer product suites of all three: practice management, billing, and electronic medical records.

Top Integrated Solutions

Stand-Alone

While integration between systems is typically desirable, standalone options for billing still enjoy decent demand. These systems may have smaller feature sets, or may offer a range of functions because the vendor designed the product to handle the needs of the user without help from other systems. As always, it varies from product to product. Stand-alone systems may hold strong appeal to providers who are opening a new practice and need to keep overhead low, or for provides who don’t plan to adopt an EHR in the near future. Stand-alone systems can also be purchased as a single piece of a larger product suite, such as NueMD’s billing system.

Top Stand-Alone Solutions

Market Trends

ICD-10

While the industry-wide transition to the new classification set has been pushed back until 2015, it still behooves buyers to choose products that feature ICD-10 functionality. Products that offer some type of coding assistance are ideal, because ICD-10 contains more granular diagnostic codes in order to help expedite the claims process. As a result, coding in ICD-10 will be more complex than its ICD-9 forbearer, and physicians must prepare accordingly.

Cloud Deployment

Instead of buying dedicated servers that must be housed inside a practice and updated every 3-5 years, many providers are opting to purchase cloud-based EHRs, PM systems, and billing software. Remotely-hosted software requires less upfront investment and long term maintenance. However, monthly subscription fees may actually exceed these costs over a five year (or greater) span.

Outsourcing

Some providers may choose to outsource their billing to a medical billing firm, or even a medical software vendor. Vendors such as Kareo offer outsourced billing services in exchange for a percentage of the received reimbursement. Software vendors aren’t the only organizations to offer such services. Dedicated billing firms also supply providers with the option of letting someone else handle the back and forth of claims reimbursement.